Sino-orbital metastasis as the initial presentation of advanced breast cancer

Abstract

A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.

Successful management of bilateral orbital metastases from invasive lobular breast cancer with abemaciclib and letrozole: a case report and literature review

“…Due to the anatomical constraints of the compact orbit space, these metastases usually present as space-occupying lesions, leading to significant clinical symptoms ( 31 ). Affected patients commonly exhibit limited ocular motility (55%) ( 30 , 48 , 50 , 51 , 54 – 58 , 60 , 61 , 64 , 65 , 67 – 71 , 73 – 77 ), vision loss (29%) ( 51 , 53 , 54 , 56 , 57 , 59 , 63 , 64 , 68 , 71 , 75 , 77 ), periorbital edema (24%) ( 30 , 52 , 53 , 59 , 62 , 65 , 66 , 68 , 69 , 76 ), diplopia (21%) ( 48 , 55 , 57 , 58 , 64 , 67 , 70 , 71 , 73 ), proptosis (14%) ( 47 , 51 – 53 , 56 , 59 ), ptosis (14%) ( 53 , 54 , 69 , 73 , 75 , 77 ), palpable mass (7%) ( 54 , 63 , 70 ), as well as dystopia ( 64 , 74 ), and upper lid retraction ( 53 , 67 ) (both 5%). A notable and intriguing occurrence is enophthalmos, observed in 2 cases (5%) ( 61 , 75 ).…”

“…Affected patients commonly exhibit limited ocular motility (55%) ( 30 , 48 , 50 , 51 , 54 – 58 , 60 , 61 , 64 , 65 , 67 – 71 , 73 – 77 ), vision loss (29%) ( 51 , 53 , 54 , 56 , 57 , 59 , 63 , 64 , 68 , 71 , 75 , 77 ), periorbital edema (24%) ( 30 , 52 , 53 , 59 , 62 , 65 , 66 , 68 , 69 , 76 ), diplopia (21%) ( 48 , 55 , 57 , 58 , 64 , 67 , 70 , 71 , 73 ), proptosis (14%) ( 47 , 51 – 53 , 56 , 59 ), ptosis (14%) ( 53 , 54 , 69 , 73 , 75 , 77 ), palpable mass (7%) ( 54 , 63 , 70 ), as well as dystopia ( 64 , 74 ), and upper lid retraction ( 53 , 67 ) (both 5%). A notable and intriguing occurrence is enophthalmos, observed in 2 cases (5%) ( 61 , 75 ). This is likely due to the infiltration of neoplastic cells into the extraocular muscles and retro-bulbar stromal tissues, leading to desmoplasia, fibrosis, and the retraction of the eye globe ( 78 ).…”

“…This is likely due to the infiltration of neoplastic cells into the extraocular muscles and retro-bulbar stromal tissues, leading to desmoplasia, fibrosis, and the retraction of the eye globe ( 78 ). The majority of orbital metastases exhibit lobular histology (50%) ( 30 , 42 , 47 , 52 , 53 , 55 , 57 , 58 , 60 , 62 , 65 – 67 , 69 , 72 , 76 , 77 ) vs. ductal (14%) ( 56 , 59 , 64 , 71 , 72 , 75 ) ( 48 , 61 , 74 ) vs. mixed (5%) ( 72 ), a trend that is consistent throughout existing literature ( 42 ). The immunophenotype of these clinical cases is predominantly hormone receptor-positive in breast cancer, specifically belonging to the luminal subtype ( 42 , 47 , 56 , 62 , 64 – 66 , 69 , 72 , 76 ).…”